Aid for the Pore

Having tackled wrinkles and sunspots, dermatologists are taking on a small but pesky new nemesis: the enlarged pore. Jane Larkworthy offers her cheek.

“I’ll be happy when I’m 60.” That was the affirmation with which I comforted myself from the onset of puberty through my mid-30s, when my pores seemed to spew more grease than a Texas oil well, providing my cheeks, nose, and chin with a perpetual, deeply unflattering sheen. All of that “moisture,” I had read, would render me a supple, dewy-skinned woman of a certain age, while my pimple-free, matte-faced friends would prematurely wrinkle like cheap linen.

Though I’m still years away from an AARP membership, I am indeed grateful for how that 20-plus-year-old oil slick has helped stem the tide of aging. But to say that I’m “happy” with my skin would be an overstatement: The oil wells have, blessedly, dried up, but they’ve left large, visible pores in their wake.

According to cosmetic dermatologist Fredric Brandt, who has practices in Coral Gables, Florida, and New York, I am far from alone. Brandt offers everything from spot correctors to wrinkle smoothers in his eponymous skincare collection. But the products in his Pores No More line—which include cleansers, mattifiers, and refiners—are his top sellers. It’s not that enlarged pores are a new epidemic, he says, but rather that, after injecting and lasering away our lines and sun splotches, we now have the luxury of focusing on (literally) the smaller stuff. “It’s like when you renovate a house,” Brandt says. “Suddenly you notice all the little things that haven’t been redone.”

According to Brandt, there are two main reasons why pores expand as we age. First, skin-cell turnover slows, causing clogs that, over time, stretch out the once tiny openings. Second, hormonal changes signal the skin to produce less collagen and elastin, weakening the walls of pores so that instead of holding taut, they begin to gape.

One U.K. study found that estrogen, administered topically, helped decrease pore size, but, as anyone who has undergone hormone replacement therapy—or even taken birth control pills—knows, messing with estrogen is not without complications. Doctors in the United States, understandably, have mostly opted to steer clear of hormones, instead relying on lasers, lights, and other high-tech gadgetry to do the job—and there is plenty to choose from.

Los Angeles dermatologist Peter Kopelson’s favorite pore shrinker is the Regenlite, a laser developed to treat acne. It works by causing the body to secrete a substance called Transforming Growth Factor-beta, which in turn amps up collagen output and plumps pores. “We recommend a series of five treatments, one every few weeks,” Kopelson says. But many of his patients use the therapy continuously. “It’s not dangerous, and there’s no downtime,” and, at about $380 a session, he notes, it’s not particularly expensive. “I use it myself. Nothing else has reduced pore size for me.”

New York dermatologist David Colbert, on the other hand, favors Ulthera (a type of ultrasound) and Fraxel (a fractionated laser), both of which stimulate fibroblasts, the cells that produce collagen and elastin. Ulthera, the less invasive of the two, is a one-shot deal that costs around $5,000. Fraxel, Colbert’s go-to for older patients with accumulated sun damage, works best when three or four treatments are spaced out over a few months. (He charges $1,500 a session.) For those not ready to make such a commitment, Colbert turns to microdermabrasion or chemical exfoliation (like a glycolic acid and lavender essence peel) to encourage skin-cell turnover. He also assigns homework: “Everyone should use Retin-A,” he insists. “It’s the only FDA-approved drug that signals cells to make more collagen and elastin.”

Indeed, in the eyes of most dermatologists, retinoid remains the miracle cure. In addition to boosting collagen and elastin, “retinoids exfoliate, so pores look smoother,” says the dermatologist Anne Chapas, who runs New York’s Union Square Laser Dermatology. Retinoids, which in the past were often too harsh for sensitive skin, now come in a variety of strengths and formulations, including the milder and moisturizing Renova. Some no longer even require a prescription. “We’re starting to see over-the-counter retinoid products that actually do a good job,” Chapas says.

Personally, I have noticed positive changes with the Clear + Brilliant machine, a fractionated laser similar to but gentler than Fraxel. Because it penetrates less deeply, recovery time is a few hours, as opposed to the five to seven days of post-procedure redness and swelling that Fraxel patients can experience. “It promotes overall radiance, improved skin texture, smaller pores, and fewer fine lines,” says Amy Wechsler, the New York dermatologist to whom I’ve been going for treatments.

Wechsler warned me not to expect changes until I’d had five or six treatments (fortunately, at $500 a visit, it’s significantly cheaper than Fraxel), but I was excited to give it a try. So a few months ago I began diligently showing up at her office every three weeks, applying numbing cream (all of these treatments involve a little sting), and getting zapped. After five visits with no visible effect, I was beginning to lose hope, but just as Wechsler had predicted, I turned a corner at visit number six. My skin suddenly seemed firmer, smoother—and best of all, my pores were no longer the first things I noticed when I looked in the mirror.

So for now, I’m committed to monthly touch-ups with Wechsler, but I’m slowly working up the nerve to try the next wave of cosmetic dermatology: a more permanent but slightly queasy-making procedure called Laviv. A piece of healthy, hidden-from-sun skin is ­removed (usually from behind the patient’s ear) and sent to a lab to propagate new, healthy fibroblasts. After three months, the fibroblasts are injected into the skin where needed over three sessions. “You’re basically regenerating your own collagen,” explains Brandt, who has been performing Laviv since it got FDA approval in June 2011. “We’ve noticed lines diminishing and pores shrinking,” he enthuses. “Patient satisfaction has been very high.” Maybe I’ll try it when I finally do turn 60.